RUHS, Jaipur, PB B.Sc Nursing Entrance-2022
Fundamental of Nursing
Medium
Which of the following patient should nurse assess first?
Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2022
Explanation
- The core principle for prioritizing nursing care is the ABC (Airway, Breathing, Circulation) framework.
- A patient receiving oxygen has a compromised 'Breathing' status, which is a high-priority, potentially life-threatening condition.
- This patient requires immediate assessment to ensure the oxygen therapy is effective and to monitor for any signs of respiratory deterioration.
- According to the ABCDE principle, issues with breathing are second only to a compromised airway in terms of priority.
Why Other Options Were Wrong
- Option B: A postoperative patient being prepared for discharge is considered medically stable. Their immediate, life-threatening needs have been resolved, making their assessment a low priority.
- Option C: A patient scheduled for a routine chest x-ray is typically stable. This is a planned diagnostic test, not an emergency intervention, and thus is a lower priority.
- Option D: A routine dressing change is an important but not an urgent task. It addresses needs related to infection control and wound healing, which are not as immediately life-threatening as a breathing problem.
Related Visual
Clinical Relevance
- Nursing practice connection: Use the key finding related to Nursing Prioritization to guide bedside assessment, documentation, and the next nursing action.
- Prioritization is a critical skill in nursing that ensures the most unstable patients receive care first, preventing adverse outcomes and improving patient safety.
- Using frameworks like ABCs or Maslow's Hierarchy of Needs provides a systematic and defensible method for making complex clinical decisions about patient care.
- What if? If the patient requiring a dressing change had a saturated dressing with bright red blood, they would become a high priority under 'C' for Circulation. The nurse would then need to quickly assess both the bleeding patient and the oxygen-dependent patient to see who is more unstable at that moment.
How to Approach the Question
- First, identify the question as a prioritization question. Keywords like 'first', 'priority', or 'most important' are clues.
- Recall the standard prioritization frameworks in nursing, primarily the ABCs (Airway, Breathing, Circulation).
- Analyze each option to determine which patient is the most unstable or has the most life-threatening condition.
- Categorize each patient's need within the ABC framework. The patient receiving oxygen clearly falls under 'B' for Breathing.
- Compare the needs. A 'Breathing' problem is more immediate than a stable patient ready for discharge, a routine test, or a routine dressing change.
- Select the option that represents the highest priority according to the ABC framework.
Concept Tested & Keywords
- Concept Tested: Nursing Prioritization
- Stem keywords: nurse, assess first
- Lead-in keywords: first
- Negative lead-in flag: false
Question ID
QvODykAUeYuXHkKFDFKyq4
Reference Book
E6 Nursing Fundamentals Potter Perry 12e Part 1 p. 246-248
E6 Nursing Fundamentals Potter Perry 12e Part 2 p. 22-24
E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 194-196
Practise the full RUHS, Jaipur, PB B.Sc Nursing Entrance-2022
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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